急性ST段抬高心肌梗死患者左室结构功能及二级预防状况的随访观察

摘要

Objective To follow-up the dynamic changes and secondary prevention of left ventricular structure and function in patients with acute ST segment elevation myocardial infarction (STEMI).Methods Eighty patients with acute STEMI who received no emergent reperfusions were collected.Cardiac structure and function were assessed by echocardiography at admission and 3-year follow-up.Results Compared with the baseline,LVEDD,LVM,LVMI, LVEDV,LVESV and E /A ratio increased significantly(P =0.033,P =0.046,P =0.045,P =0.048,P =0.008 and P =0.042,respectively),and the LVEF decreased dramatically(P =0.003).After 3 years,the proportion of angioten-sin-converting enzyme inhibitors,β-blockers and statins were 51.3%,68.8% and 53.8% respectively,which de-creased significantly.The achieved rate of blood pressure,low-density lipoprotein cholesterol and body mass index were 37.5%,17.5% and 26.3%,respectively.Conclusion Patients have a left ventricular remodeling after AMI,the situ-ation of secondary prevention is not optimistic.%目的：随访观察急性 ST 段抬高心肌梗死（STEMI）患者左室结构功能3年的动态变化以及二级预防状况。方法横断面调查初发但因就诊延迟，未急诊再灌注治疗的急性 STEMI 患者80例，其中男性65例，女性15例；年龄43～83岁，平均年龄62岁。采用超声心动图评价患者左室结构及功能，记录患者的基线以及二级预防状况的临床资料。结果3年随访期时较急性期左室舒张末内径扩大（P ＝0．033），左室舒张末容积（P ＝0．048）及收缩末容积扩大（P ＝0．008），左室质量（P ＝0．046）及左室质量指数增加（P ＝0．045），相对室壁厚度变薄（P ＝0．031），射血分数减低（P ＝0．003），E ／A 比值增加（P ＝0．042），但 E ／A 比值均值仍小于1。3年随访时，STEMI 患者应用血管紧张素受体拮抗剂、β受体阻滞剂及他汀类药物的比例较住院期间显著降低，分别为51．3％、68．8％及53．8％，血压、低密度脂蛋白胆固醇及体质量指数达标率较低，分别为37．5％、17．5％及26．3％。结论心肌梗死后存在左室重塑，患者出院后二级预防状况不容乐观，应强化随访。